AUC Macros: Counseling
Counseling viral URI
-Proper handwashing and proper methods of covering coughs and sneezes.
-Patients who smoke should receive smoking cessation encouragement and materials.
-When antibiotics are prescribed, complete the full course of antibiotic therapy.
-Patients should be instructed to follow up when indicated or if symptoms worsen.
patients with infectious mononucleosis should be instructed to avoid contact sports for 6 weeks because of the possibility of splenic rupture.
-Purulent nasal secretions do not predict bacterial sinusitis unless accompanied by other signs and symptoms of bacterial
infection.
-Treatment with an antibiotic does not shorten the duration of illness or prevent bacterial rhinosinusitis.
-Patients with purulent green or yellow secretions do not benefit from antibiotic treatment.
Counseling arthropod bite
Insect bite is treated symptomatically, unlessspecific insect was seen and identified.
Wear protective clothing (ie, long pants, long sleeves), especially when outdoors. Many insects are incapable of biting through clothing. Additionally, light-colored clothing appears to be less attractive to many biting insects, including mosquitos. Avoid dark colors or brightly colored floral patterns. Wear protective footwear. Wear gloves when working with soil or in areas of heavy infestation.
Avoid use of heavy perfumes, scented soaps, sprays, or lotions that may attract insects. Be aware of surroundings; for example, avoid dense vegetation or animals suspected of carrying fleas, chiggers, or ticks. Prudent use of insect repellent can help minimize exposure to insect bites and stings. Be aware of the potential for bees or other foraging insects to enter opened soft drink containers that are left idle.
COUNSELING AUD
Amphetamine use disorder involves the recreational use (other than for an approved medical indication) of a class of non-catecholamine sympathomimetic amines - specifically, amphetamines, methamphetamines, and 3,4-methylenedioxymethamphetamine (MDMA or ecstasy), misused by oral and intravenous routes, nasal insufflation (snorting), and inhalation (smoking), resulting in either acute or chronic toxicity.
Amphetamine use disorder is described as one of the substance-related disorders.
Acute toxicity and chronic misuse
The acute or immediate toxicity with an overdose is associated with a high or excessive acute drug intake; the manifestations are often exaggerated effects of normal effects of the drug. This action phase is associated with long periods without food or sleep, followed by a reaction or recovery phase characterized by exhaustion and fatigue giving way to long periods of sleep and periods of extreme hunger.
Chronic misuse refers to repeated use over months or years causing recurrent and clinically adverse effects. These consequences may be substance-related legal problems; depression; failure to fulfill occupational, family, or social obligations; and continued use despite danger to self or destructive effects on quality of life.
COUNSELING BRAT diet
The BRAT diet may be recommended for recovery from gastroenteritis or other causes of nausea, vomiting, diarrhea, or stomach upset. It also helps some women who are suffering from morning sickness during pregnancy.
Of course, while following the BRAT diet or when recovering from any illness, it is important to drink enough fluids to prevent dehydration. Supplementing water intake with a sports drink or an electrolyte drink such as Pedialyte can help replace lost electrolytes as well as fluids.
While recovering from a gastrointestinal illness and transitioning back to a normal diet, it's also recommended to avoid fatty and greasy foods, raw fruits and vegetables, alcohol, dairy products, and citrus fruits.
Counseling BRCA Genetic Screen
Advised pt the USPSTF recommends that primary care providers screen women who have family members with breast, ovarian, tubal, or peritoneal cancer with 1 of several screening tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2). Women with positive screening results should receive genetic counseling and, if indicated after counseling, BRCA testing.
genetic counseling includes detailed kindred analysis and risk assessment for potentially harmful BRCA mutations; education about the possible results of testing and their implications; identification of affected family members who may be preferred candidates for testing; outlining options for screening, risk-reducing medications, or surgery for eligible patients; and follow-up counseling for interpretation of test results.
Tools:
https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing#table-1-ontario-family-history-assessment-tool
Approximately 15 minutes spent counseling patient on this topic.
COUNSELING Caffeine
U.S. government dietary guidelines suggest adults may consume up to 400 mg of caffeine a day as part of their diet. This quantity is equivalent to around three to five 8-ounce cups of coffee.
Regularly consuming high doses of caffeine may cause long-term health problems, including:
stomach ulcers
difficulty sleeping
anxiety and depression
For most people, caffeine consumption is unlikely to lead to an overdose or long-term health problems. People who consume caffeine regularly develop a tolerance to some of its side effects. Drinking coffee in moderation may also have health benefits.
Being aware of the amount of caffeine found in food, drink, and supplements can help. A person may therefore choose to have a smaller-sized coffee, alternate regular with decaffeinated coffee, or opt for decaffeinated hot drinks, such as herbal teas.
Counseling Cannabis Use
Counseled for 7.5 minutes on daily cannabis use and it's potential for negative effects on the cardiovascular and respiratory systems. Because it has been a schedule 1 drug, researchers have not been able to carry out for very long yet. There is some evidence that smoking of cannabis specifically can raise blood pressure, which over time can lead to negative cardiovascular effects. Smoke inhalation of any kind is detrimental to the lungs and should be avoided where possible. Consuming edible cannabis is a viable alternative, but one should realize this can lead to anxiety/panic attacks, that research is still lacking on frequent use, and that no one should operate a vehicle after consumption of any mind-altering substance.
Counseling Cervical CA Screen
Advised pt that screening women ages 21 to 65 years every 3 years with cytology provides a reasonable balance between benefits and harms.Screening with cytology more often than every 3 years confers little additional benefit, with large increases in harms.HPV testing combined with cytology (co-testing) every 5 years in women ages 30 to 65 years offers a comparable balance of benefits and harms, and is therefore a reasonable alternative for women in this age group who would prefer to extend the screening interval.
Approximately 15 minutes spent counseling patient on this topic.
Counseling Colonoscopy
Colonoscopy is considered the gold standard for colon cancer screening and surveillance. The age at which screening starts will depend upon the patient's medical and family history. If polyps are found during colonoscopy, they should be removed endoscopically if possible (Uptodate). The ACS recommends that people at average risk* of colorectal cancer start regular screening at age 45, and the USPSTF recommends starting at age 50. This can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test that requires more frequent screening), or with an exam that looks at the colon and rectum (a visual exam). These options are listed below. People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of 75. For people ages 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health, and prior screening history. *For screening, people are considered to be at average risk if they do not have:
1. A personal history of colorectal cancer or certain types of polyps
2. A family history of colorectal cancer
3. A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
4. A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
5. A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer
(Info taken from uptodate and cancer.org)
Counseling provided for 7.5-10 minutes.
counseling: Dehydration
Patient counseled for 10 minutes on dehydration, covered side effects and symptoms:
You can become dehydrated because of: Diarrhea, Vomiting, Sweating too much, Urinating too much, which can happen because of certain medicines and illnesses such as: Fever, Not drinking enough. Dehydration can be mild, or it can be severe enough to be life-threatening. Get medical help right away if the symptoms also include. Confusion, Fainting, Lack of urination, Rapid heartbeat, Rapid breathing, Shock. The key to preventing dehydration is making sure that you get enough fluids: Drink enough water every day. Each person's needs can be different, so ask your health care provider how much you should be drinking each day. If you are exercising in the heat and losing a lot of minerals in sweat, sports drinks can be helpful. Avoid drinks that have sugar and caffeine. Drink extra fluids when the weather is hot or when you are sick.
counseling Depression Yesim
Counseled about depression and med side effects including increased risk of SI and HI and addiction risks with esp BNZ approximately for 10 minutes.:
*** According to the National Suicide Prevention Lifeline, warning signs:
Talking about wanting to die or wanting to kill yourself
Looking for a way to kill yourself, such as searching online for methods or buying a gun
Talking about feeling hopeless or having no reason to live
Talking about feeling trapped or in unbearable pain
Talking about being a burden to others
Increasing use of alcohol or drugs
Acting anxious or agitated; behaving recklessly
Sleeping too little or too much
Withdrawing or feeling isolated
Showing rage or talking about seeking revenge
Displaying extreme mood swings
Getting Help
*** Be aware that often, suicidal behavior is impulsive. Remove any weapons, medications, or other means that you might use to harm yourself. If you own a gun or other weapon, ask a trusted person to keep it away from you. Get rid of stockpiled pills by placing them in a bag with cat litter or dirt and disposing of the entire package. By getting such items out of your surroundings, you may buy time -- enough valuable time for you to overcome a suicidal impulse and to consider other ways to cope with your pain.
Avoid using alcohol or illegal drugs, or seek treatment to break dependence on these substances. They can worsen your depression and lead to thoughts of suicide. Some studies have found that among people who have completed suicide, 33%-69% have had alcohol detected in their blood.
If you are severely depressed or have suicidal thoughts, tell your primary care doctor, psychiatrist, or therapist. Or call the National Suicide Prevention Lifeline anytime at (800) 273-TALK.
If you feel that you can't control the urge to harm yourself, or if you've already taken steps to harm yourself, call 911 or go to the emergency room without delay. You may need to be hospitalized for supervised treatment to reduce the risk of suicide.
Counseling: Diet/Lifestyle
Counseled patient for 10 minutes about adopting healthy diet and lifestyle to prevent chronic diseases
-Be physically active for 30 minutes most days of the week. Break this up into three 10-minute sessions when pressed for time. Healthy
movement may include walking, sports, dancing, yoga or running.
-Eat a well-balanced, low-fat diet with lots of fruits, vegetables, and whole grains. Choose a diet that's low in saturated fat and cholesterol,
and moderate in sugar, salt and total fat.
Counseling - Exercise
Physical inactivity leads to at least 250,000 deaths annually in the United States, and more than one half of Americans fail to meet recommended physical activity levels. Regular physical activity decreases total mortality rates as well as the incidence and mortality of cardiovascular disease, diabetes, and some cancers. Physical activity improves mental health and control of diabetes, hypertension, and lipid levels; prevents osteoporosis; and, especially in older patients, sustains mobility, reduces disability, and decreases the risk of falls.
The Centers for Disease Control and Prevention, American College of Sports Medicine, U.S. Surgeon General, and American College of Preventive Medicine recommend that adults participate in at least 30 minutes of accumulated moderate-intensity physical activity (i.e., walking fast [3 to 4 miles per hour] or the equivalent) on five or more days of the week.The following are key principles for physical activity: (1) the more activity the better, (2) accumulated time is more important than intensity, (3) activity can be accumulated in 10-minute increments, and (4) lifestyle activities (e.g., substituting walking or biking for short car rides, using a push rather than a riding lawn mower) are more likely to be sustained than structured activities (e.g., exercising at a gym).
Approximately 15 minutes spent counseling patient on this topic.
Counseling Fall Prevention
According to the USPSTF, Falls in the elderly are the number one cause of injury-related morbidity and mortality in this population. >28% of those >65 y/o in the US reported falling in 2014, a staggering 29 million falls. This resulted in ~33,000 deaths and complications for many more. Several measures can be taken to reduce likelihood of fall. 1. Have no rugs in the home. 2. Don't have small animals which get under the feet. 3. Install nightlights in that make passageways visible at night. 4. Keep passageways clear. 5. Use non-slip rubber mats in the shower. 6. Wear shoes indoors. 7. Talk to your doctor if any medications are reducing your blood pressure below the normal range or making you drowsy or dizzy. 8. Have a plan in the event of fire, and be prepared to utilize it. Exercise interventions can also be used to reduce the likelihood of falls and should be utilized where practical. Physical therapy, group exercises, and individual exercise can all be of benefit.
Counseling offered x 7.5-10 minutes.
Counseling Gout Diet
AVOID: red meat, organ meat, seafood high in mercury, alcohol, and sugary snacks/beverages.
EAT: eggs, low-fat dairy products, whole grains, nuts/seeds, foods high in omega-3 fatty acids, coffee, green vegetables, beetroot, red bell pepper, squash, cabbage, kailan, cherries, citrus, and herbs and spices such as turmeric, cinnamon, chamomile, and nutmeg.
CONSUME IN MODERATION: pears, avocados, apples, pineapples, spinach, mushrooms, cauliflower, and asparagus in moderation.
Counseling: Handwashing
-Patient educated on proper hand hygiene to prevent spread of infection:
Washing hands can keep you healthy and prevent the spread of respiratory and diarrhea infections from one person to the next.
Germs can spread from other people or surfaces when you: Touch your eyes, nose, and mouth with unwashed hands, Prepare or eat
food and drinks with unwashed hands, Touch a contaminated surface or objects, Blow your nose, cough, or sneeze into hands and
then touch other people’s hands or common objects, Don't wash your hand after using restroom.
Washing your hands is easy, and it’s one of the most effective ways to prevent the spread of germs. Clean hands can stop germs from
spreading from one person to another and throughout an entire community—from your home and workplace to childcare facilities and
hospitals. Follow these steps every time: Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your
nails. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
Rinse your hands well under clean, running water. Dry your hands using a clean towel or air dry them.
Approximately 10 minutes spent counseling patient on infection prevention.
Counseling HLD-MC
Eat plenty of fresh fruits and vegetables. Fruits and vegetables are naturally low in fat. Pick “good” fats over “bad” fats.Use healthier cooking methods,Look for other sources of protein,Get more fiber ,Eat more fish, Limit how much cholesterol you get in your diet.
Approximately 15 minutes spent counseling patient on this topic.
Counseling HPV Vaccine
The HPV vaccine is recommended around age 11. HPV is a virus which can cause many conditions including genital warts, cervical cancer, and oral cancer. The vaccine works to prevent contracting these high risk types. It is recommended before the patient becomes sexually active since the intention is prevention. The vaccine comes in 2 doses. Dose 2 is given 6-12 months after Dose 1.
Counseling provided for 7.5 minutes.
Counseling Hypertension
The initial approach to managing HTN will be lifelong lifestyle modification including:
1. Sodium reduction (=2.4 g/day)
2. DASH diet (8-10 servings of fruit and vegetables daily, whole grains, low sodium, low-fat proteins)
3. Waist circumference: <40 inches (<102 cm) for men and <35 inches (<88 cm) for women
4. Increased physical activity: at least 30 minutes of moderate-intensity dynamic aerobic exercise (walking, jogging, cycling, or swimming) 5 days per week to total 150 minutes per week, as tolerated or recommended by physician. Prior to initiation of an exercise program, patients should discuss a plan with their healthcare provider.
5. Limited alcohol consumption: <20-30 g alcohol per day in hypertensive men; <10-20 g alcohol per day in hypertensive women. Total weekly alcohol consumption should not exceed 140 g for men and 80 g for women.
Approximately 15 minutes spent counseling patient on this topic.
Driving Precautions
The following safety topics were discussed with the patient.
1. Advised pt to always wear seat belt when driving or riding in a vehicle.
2. Advised pt to avoid drinking and driving.
3. Advised pt to drive at posted speed limits.
4. Advised pt to wear helmets when driving motorcycle or riding bicycle.
5. Advised pt to have adequate amount of smoke detectors in household.
Approximately 15 minutes spent counseling patient on this topic.
Counseling Mammogram
Malignant neoplasm of the breast is the 2nd most commonly diagnosed of cancer following lung cancer. It is the # 1 cause of cancer-related death in females worldwide (#2 US). It can be genetic (BRCA gene), and this should be screened for if there are high rates of breast/ovarian/etc. cancers in the family. However, most breast cancer is not genetic in nature. Guidelines for screening differ between organizations. ACOG recommends starting at age 40 and continuing annually for as long as the woman is healthy and can tolerate it. The ACS recommends starting at age 45 and performing annually until age 55 when the frequency can become every 1-2 years depending on preference. They recommend continuing this until life expectancy is <10 years. The USPSTF recommends starting at age 50 and performing every 2 years until age 74. Pros and cons of starting mammograms early should be discussed including radiation exposure and invasive workups (cons) versus potentially catching breast cancer which might have otherwise been missed otherwise (pro).
7.5 to 10 minutes spent counseling on this topic.
Counseling OB
COUNSELED on OB care:
1. Begin taking prenatal vitamins.
2. Follow a healthy, safe diet, get regular exercise, avoid exposure to potentially harmful
substances such as lead and radiation can help reduce the risk for problems during pregnancy
and promote fetal health and development. Monitor blood pressure
3. Avoid tobacco smoke and alcohol use during pregnancy.
Referral to OB/gyn to continue prenatal care.
Approximately 15 minutes spent counseling patient on this topic.
Counseling-Obesity & HTN
COUNSELED PT: Advised weight loss, limit carb intake, low sodium diet, encouraged physical activity daily for at least 30 minutes per day, encouraged some form of relaxation technique.
Educated pt that hypertension is a silent killer and ongoing monitoring is required to prevent heart attack and stroke.
Approximately 15 minutes spent counseling patient on this topic.
Counseling Pap Smears
Pap smears are important for early detection of cervical cell changes which may lead to cervical cancer. Cervical cancer used to be a leading cause of cancer death in women before screening. It is currently recommended per ACOG guidelines that pap smears be started at 21 years of age and be performed every 3 years initially. These same guidelines recommend starting cotesting for HPV with pap smears every 5 years starting at age 30. The HPV vaccine can significantly reduce the risk of contracting high risk HPV that leads to cervical cancer. ACS guidelines no longer dictate that pap smears need start at age 21.
Counseling provided for 7.5 minutes.
Counseling Prevent Skin CA
Advised pt to reduce UV radiation exposure by including use of broadspectrum, sunscreen with a sun-protection factor of 15 or greater; wearing hats, sunglasses, or sun-protective clothing; avoiding sun, exposure; seeking shade during midday hours (10 am to 4 pm); and avoiding indoor tanning use.
Approximately 15 minutes spent counseling patient on this topic.
Counseling Prostate CA Screening
The USPSTF lists prostate cancer screening as a grade C recommendation. Some prostate cancer, which may in a small # of cases have become advanced, will be caught by regular screening. However, many individuals have prostate cancer which grows so slowly that it never causes any fatal issues. Given this finding and the fact that regular prostate screening may lead to overly invasive procedures/testing, it is recommended that the patient be educated about pros and cons. The decision to screen should be individualized, and no provider should screen patients who would rather not engage in this practice.
7.5-10 minutes spent counseling.
Counseling self-breast E. Yesim
****counseling for self breast exam was provided approximately for 10 minutes.
How to do a breast self-exam: The five steps
*Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips. Here's what you should look for:
Breasts that are their usual size, shape, and color
Breasts that are evenly shaped without visible distortion or swelling
If you see any of the following changes, bring them to your doctor's attention:
Dimpling, puckering, or bulging of the skin
A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out)
Redness, soreness, rash, or swelling
*Step 2: Now, raise your arms and look for the same changes.
*Step 3: While you're at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood).
*Step 4: Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter.
Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.
Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. This up-and-down approach seems to work best for most women. Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you've reached the deep tissue, you should be able to feel down to your ribcage.
*Step 5: Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in step 4.
Don’t panic if you think you feel a lump in your breast. Most women have some lumps or lumpy areas in their breasts all the time, and most breast lumps turn out to be benign (not cancer). There are a number of possible causes of non-cancerous breast lumps, including normal hormonal changes, a benign breast condition, or an injury.
Don’t hesitate to call your doctor if you’ve noticed a lump or other breast change that is new and worrisome. This is especially true for changes that last more than one full menstrual cycle or seem to get bigger or more prominent in some way. If you menstruate, you may want to wait until after your period to see if the lump or other breast change disappears on its own before calling your doctor.
Counseling Shingles Vaccination
People who have been infected with VZV are at risk of reactivation VZV and subsequent development of herpes zoster (shingles). Shingles is an often painful condition that can lead to complications such as secondary infection, post-herpetic neuralgia, and vision loss if it affects the eyes. The Shingrix (RZV) vaccine is indicated in individuals > or equal to 50 years old. ZVL (Zostavax) is currently contraindicated in immunocompromised hosts. The decision to vaccinate immunocompromised hosts with Shingrix should be made on a case by case basis. There is theoretical potential that the vaccine could cause flare or graft rejection in patients with autoimmune disease or organ transplant, respectively. Patient should be informed of these risks and be allowed to make an informed decision regarding vaccination.
Counseling Sleep Hygiene
1. Limiting daytime naps to 30 minutes . Napping does not make up for inadequate nighttime sleep. However, a short nap of 20-30 minutes can help to improve mood, alertness and performance.
2. Avoiding stimulants such as caffeine and nicotine close to bedtime.
3. Exercising to promote good quality sleep. As little as 10 minutes of aerobic exercise, such as walking or cycling, can drastically improve nighttime sleep quality. For the best night’s sleep, most people should avoid strenuous workouts close to bedtime. However, the effect of intense nighttime exercise on sleep differs from person to person, so find out what works best for you.
4. Steering clear of food that can be disruptive right before sleep. Heavy or rich foods, fatty or fried meals, spicy dishes, citrus fruits, and carbonated drinks can trigger indigestion for some people. When this occurs close to bedtime, it can lead to painful heartburn that disrupts sleep.
5. Ensuring adequate exposure to natural light. This is particularly important for individuals who may not venture outside frequently. Exposure to sunlight during the day, as well as darkness at night, helps to maintain a healthy sleep-wake cycle.
5. Establishing a regular relaxing bedtime routine. A regular nightly routine helps the body recognize that it is bedtime. This could include taking warm shower or bath, reading a book, or light stretches.
6. When possible, try to avoid emotionally upsetting conversations and activities before attempting to sleep.
7. Making sure that the sleep environment is pleasant. Mattress and pillows should be comfortable. The bedroom should be cool – between 60 and 67 degrees – for optimal sleep.
8. Bright light from lamps, cell phone and TV screens can make it difficult to fall asleep, so turn those light off or adjust them when possible. Consider using blackout curtains, eye shades, ear plugs, "white noise" machines, humidifiers, fans and other devices that can make the bedroom more relaxing.
LINK: Plan: Sleep Hygiene
Counseling Smoking Cessation
Discussed smoking cessation resources such as (1-800-QUIT-NOW) which routes callers to their state quit line. The California quit line provides free cessation services, including counseling and medication. Iterated these services are effective in improving health outcomes and reducing healthcare costs for the patient.
Discussed with patient that smoking cessation is the single-most effective personal healthcare action to immediately improve health, sustain good health and prevent further disease.
Approximately 8 minutes spent counseling patient on this topic.
COUNSELING Male urethritis
Instruct patients regarding abstinence for 1 week (or until therapy is complete and symptoms have resolved) and safe sex practices (condom use) thereafter.
Nongonococcal urethritis (NGU): for patients who were initially treated with doxycycline, azithromycin (i.e., 1 g as a single dose) should be administered because the most common cause of persistent or recurrent NGU is Mycoplasma genitalium. If azithromycin fails, moxifloxacin is recommended.
In areas where Trichomonas vaginalis is prevalent, men who have sex with women and have persistent or recurrent urethritis should be presumptively treated with metronidazole or tinidazole.
Patients with persistent or recurrent NGU after presumptive treatment for M genitalium or T vaginalis should be referred to a specialist for treatment.
Treatment failures should prompt consultation with an infectious disease specialist and be reported to the Centers for Disease Control and Prevention through the local or state health department within 24 hours of diagnosis.
All sex partners within the last 60 days should be referred for evaluation and possible treatment. The management of a patient's sex partners is an important consideration to prevent reinfection and further transmission.
COUNSELING dental hygiene
Regular oral hygiene that includes brushing the teeth with a power brush and flossing or using interdental brushes is the best prevention. Although mouth rinses do reduce bacterial counts in tests subjects, no clear clinical advantages has been demonstrated.
Counseling STD
COUNSELED pt on complications of untreated sexually transmitted infections (STIs) which include upper genital tract infections, infertility, chronic pelvic pain, cervical cancer, and chronic infection with hepatitis viruses and HIV. Many patients have asymptomatic disease, and screening for infection is thus an important approach to identify and treat infected individuals who would otherwise go undetected.
**Also recommended: for MSM, we screen at least annually for syphilis, genital chlamydia and gonorrhea. More frequent screening every three months is warranted for MSM at particularly high risk for STIs, including those with multiple or anonymous partners. We perform one-time screening for hepatitis A virus (HAV) and HBV, with vaccination if susceptible, and at least one time screening for HCV.
Approximately 15 minutes spent counseling patient on this topic.
Counseling Travel Med-Yesim
For travel:
Based on CDC : https://wwwnc.cdc.gov/travel/destinations/traveler/none/congo
1. patient is Up to date with all childhood vaccination
2. Based on CDC recommendation patient will need to get ?? vaccination. rx send to pharmacy.
3. Patient did not want to get Rabies vaccination. Patient is explained that they can have rabies vaccination shortage and if she gets a dog bite, she may not be able to get proper prophylaxes and advised her tp contact with Santa Clara county.
4. We will send Malarone for ?? days ( she will start taking 2 days before her trip, continue to take daily everyday till 7 days after her return). Medication side effects are explained to the patient.
5. Proper hydration and drinking only bottled water
6. Do not eat any un-cooked food to prevent traveler's diarrhea. We will send Cipro for 7 days for traveler's diarrhea
7.For urinary tract infection; proper hydration, not to hold the urination. For UTI, we will send Bactrim DS twice a day
8. patient will get OTC Pepto-Bismol, Imodium and Zyrtec for upset stomach, diarrhea and allergies.
9. For jet-lag we will send rx Ambien for 5 days.
10. Please use sunscreen and sun protective clothing : Use a sunscreen with a Sun Protection Factor (SPF) of 15 or higher. Sunscreens come in many forms, including ointments, creams, gels, lotions, wax sticks, and sprays.
Follow the directions on the package. The sun’s UV rays can damage your skin in as little as 15 minutes. Put sunscreen on before you go outside, even on slightly cloudy or cool days. Don’t forget to put a thick layer on all parts of exposed skin. Get help for hard-to-reach places like your back. Sunscreen wears off. Put it on again if you stay out in the sun for more than 2 hours, and after you swim or do things that make you sweat.
11. For mosquito bite protection: https://www.cdc.gov/mosquitoes/pdfs/MosquitoBitePreventionUS_508.pdf
* Use insect repellent: Use Environmental Protection Agency (EPA)-registered insect repellents with one of the following active ingredients: DEET, picaridin, IR3535,oil of lemon eucalyptus, para-menthane-diol, or 2-undecanone. Always follow product label instructions and Reapply insect repellent as directed. Do not spray repellent on the skin under clothing. If you are also using sunscreen, apply sunscreen first and insect repellent second. The effectiveness of non-EPA registered insect repellents, including some natural repellents, is not known.
* Wear long-sleeved shirts, pants, treat clothes and gear
*Control mosquitoes indoors • Keep windows and doors shut and use air conditioning if possible. • Use, install, or repair window and door screens. • Once a week, empty or throw out any items that hold water like vases and flowerpot saucers. • Use an indoor insect fogger or indoor insect spray to kill mosquitoes and treat areas where they rest. These products work immediately, but may need to be reapplied. Always follow label instructions.
*Control mosquitoes outdoors: • Once a week, empty or throw out any items that hold water like vases and flowerpot saucers.• Tightly cover water storage containers (buckets, rain barrels, etc.)
• For containers without lids, use mesh with holes smaller than an adult mosquito. • Use larvicides to treat large containers of water that will not be used for drinking and cannot be covered or dumped out.
• Use an outdoor insect spray in dark humid areas where mosquitoes rest, like under patio furniture or in the carpet or garage. Always follow label instructions. • If you have a septic tank, repair cracks or gaps. Cover vent or plumbing pipe openings using mesh with holes smaller than an adult mosquito
patient will contact with us if any more question or concern
If any emergency situation or concerns occurs, will seek urgent medical attention.
Counseling UTI prevention
Proper adherence to the outpatient medical regimen should be stressed. Behavior modification, such as good oral fluid intake to enhance diuresis and frequent voiding (including postintercourse voiding) may be helpful in reducing recurrent infection.
Drink plenty of water to flush out bacteria.
After urinating, and especially after having a bowel movement, always wipe from front to back. Teach children to wipe correctly.
Urinate before and after intercourse to wash away bacteria, and avoid intercourse while being treated for a UTI.
Urinate as soon as one feels the need, and empty the bladder completely.
Use lubrication during intercourse if one is dry.
If one tends to get recurrent UTIs, avoid using a diaphragm as a contraceptive. Talk to a health care provider about other birth-control options.
Do not use strong perfumed soaps, douches, feminine hygiene sprays, or powders.
Wear a new pair of clean underwear or pantyhose each day.
Wear all cotton or cotton-crotch underwear and pantyhose.
Wear loose-fitting pants.
Do not soak in a bath for more than 30 minutes at a time, and do not give children bubble baths.
***Uncircumcised men should wash the foreskin regularly, and teach uncircumcised boys how to wash their foreskin properly.
Counseling GERD Yesim
GERD diet and life style counseling for ~7.5 minutes.
TRIGGER FOODS
Some foods are known to trigger symptoms of GERD. By keeping a food diary, you can identify your trigger foods
and change your diet to reduce discomfort. Below is a list of some foods recognized to trigger symptoms of GERD
and how they affect the digestive tract:
• Coffee (with or without caffeine) and caffeinated beverages relax the lower esophageal sphincter.
• Citrus fruits and juices such as orange, grapefruit and pineapple have high acid content.
• Tomatoes and processed tomato-based products such as tomato juice, and pasta and pizza sauces are highly acidic.
• Carbonated beverages (fizzy drinks) cause gaseous distension of the stomach (bloating) which increases pressure on the lower esophageal sphincter causing acid reflux.
• Chocolate contains a chemical called methylxanthine from the cocoa tree, which is similar to caffeine. It relaxes the
lower esophageal sphincter, which causes acid reflux.
• Peppermint, garlic and onions relax the lower esophageal sphincter causing acid reflux.
• Fatty, spicy or fried foods relax the lower esophageal sphincter as well as delay stomach emptying and therefore
cause acid reflux.
LIFESTYLE CHANGES
Changing some of your habits might help your GERD. Remember to avoid
CATS: Caffeine, Alcohol, Tobacco, and Stress.
* Try limiting or stopping caffeine altogether to see if your symptoms
improve. Caffeine is found mainly in sodas, coffee, and tea.
* Do not drink alcohol.
* Stop smoking.
* Limit or reduce stress in your life. Try participating in an exercise, yoga, or meditation program.
*Avoid tight fitting clothing around the abdomen, including underwire bras.
* If you are overweight, lose weight. Even a small weight loss can help.
* Try light walking for 15-30 minutes following a meal.
* Try chewing non-mint gum for 30 minutes following a meal.
* Sleep on your left side. Remember, “right is wrong.”
* Elevate the head of your bed 6 to 8 inches to prevent reflux when you are sleeping. Extra pillows may only elevate your head. Instead: Try putting pillows between the mattress and box springs near the head of the bed or, use a special wedge. Adjustable Bed Wedge, but many are available.
counseling diet diverticulitis Y
*** Diet for Diverticulitis
1. a liquid diverticulitis diet during the active pain/ diverticulitis:
increase Water intake
Fruit juices
Broth
Ice pops
2.Gradually you can ease back into a regular diet. Your doctor may advise you to start with low-fiber foods (white bread, meat, poultry, fish, eggs, and dairy products) before introducing high-fiber foods.
3.Fiber softens and adds bulk to stools, helping them pass more easily through the colon. It also reduces pressure in the digestive tract.
4. Many studies show that eating fiber-rich foods can help control diverticular symptoms. Women younger than 51 should aim for 25 grams of fiber daily. Men younger than 51 should aim for 38 grams of fiber daily. Women 51 and older should get 21 grams daily. Men 51 and older should get 30 grams daily.
Here are a few fiber-rich foods to include in meals:
*Whole-grain breads, pastas, and cereals
*Beans (kidney beans and black beans, for example)
*Fresh fruits (apples, pears, prunes)
*Vegetables (squash, potatoes, peas, spinach)
* a fiber supplement, such as psyllium (Metamucil) or methylcellulose (Citrucel) one to three times a day. Drinking enough water and other fluids throughout the day will also help prevent constipation.
5.Foods to Avoid With Diverticulitis
In the past, doctors had recommended that people with diverticular disease (diverticulosis or diverticulitis) avoid hard-to-digest foods such as nuts, corn, popcorn, and seeds, for fear that these foods would get stuck in the diverticula and lead to inflammation. However, recent research has noted that there is no real scientific evidence to back up this recommendation.
In fact, nuts and seeds are components of many high-fiber foods, which are recommended for people with diverticular disease.
COUNSELING HPV vaccine age
Recent CDC and FDA guidance recommends that men and women up to 45 years of age get vaccinated to protect against the Human papillomavirus (HPV). HPV is the most common sexually transmitted infection and can cause certain cancers and genital warts. More than 14 million new HPV infections occur in the U.S. each year, and about 80 percent of sexually active men and women are infected with HPV at some point in their lives. (National Foundation for Infectious Diseases image).
COUNSELING Covid vaccine rxn
VAERS is a passive reporting system, meaning it relies on individuals to send in reports of their experiences. Anyone can submit a report to VAERS, including parents and patients.
Online reporting is strongly encouraged. Please report clinically important adverse events that occur after vaccination of adults and children, even if you are not sure whether the vaccine caused the adverse event.
The Vaccine Adverse Event Reporting System (VAERS) accepts all reports, including reports of vaccination errors. Guidance on reporting vaccination errors is available if you have additional questions.
COUNSELING atopic dermatitis
Treatment is carried out in a stepwise approach starting with emollients and then progressing to topical corticosteroids and calcineurin inhibitors..
Emollients improve the barrier function of the skin and are used as a part of the daily skincare regimen for all patients.
By decreasing the dryness and improving the barrier function of the skin, emollients can improve symptoms of itch and pain, in addition to decreasing exposure to bacteria and sensitizing antigens. Applying emollients after bathing may help to retain the moisture in the skin.
Topical corticosteroid agents reduce inflammation and pruritus, and are often used in short bursts for flares of atopic dermatitis. Patients are started on low- to medium-potency topical corticosteroids and may only require intermittent use on affected areas.
Low-potency: hydrocortisone, desonide.
Mid-potency: fluticasone,triamcinolone, fluocinolone.
High-potency: mometasone, betamethasone, desoximetasone.
Very high-potency: clobetasol, halobetasol, diflorasone.
Topical calcineurin inhibitors (pimecrolimus and tacrolimus) are anti-inflammatory agents that may be used as either monotherapy or combination therapy with corticosteroids for the treatment of atopic dermatitis.
Although antihistamines have not been conclusively shown to be effective for the treatment of pruritus in patients with atopic dermatitis, they can be used for their sedating effect in patients with significant sleep disturbance.
Second-generation antihistamines (e.g., fexofenadine) have shown some benefit in reduction of pruritus in adults having atopic dermatitis. In these trials, the lowering of tryptase levels was associated with a diminution of itching.
Counseling Dermabond
Dermabond Adhesive is a sterile, liquid skin adhesive that holds wound edges together. The film will usually remain in place for 5 to 10 days, then naturally fall off your skin. Do not apply liquid or ointment medications or any other product to your wound while the DERMABOND ADVANCED Adhesive is in place. These may loosen the film before your wound is healed.
You may occasionally and briefly wet your wound in the shower or bath. Do not soak or scrub your wound, do not swim, and avoid
periods of heavy perspiration until the DERMABOND ADVANCED Adhesive has naturally fallen off
• After showering or bathing, gently blot your wound dry with a soft towel. If a protective dressing is being used, apply a fresh, dry bandage, keeping the tape on the DERMABOND
• Protect your wound from injury until the skin has had sufficient time to heal
• Do not scratch, rub, or pick at the DERMABOND ADVANCED Adhesive. This may loosen the film before your wound is healed
• Protect the wound from prolonged exposure to sunlight or tanning lamps while the film is in place.
Counseling PMS
Postmenopause begins once you’ve officially reached menopause: 12 months after your last period.
The average age of menopause for US women is 51. Most women reach this milestone somewhere between ages 45 and 55.
Most experts recommend taking the lowest dose HRT for the shortest duration. The older you are, the greater the risks. Treating someone who’s 55 is lower risk than 85.
Hormone replacement therapy (HRT) is an option for many women who wish to combat the health risks that increase during their postmenopausal years. But this therapy may have its own risks.
Benefits: Estrogen therapy (with or without progesterone) may relieve hot flashes, night sweats, vaginal dryness and protect against bone loss.
Risks: Estrogen-only therapy may increase your risk of breast and uterine cancer, stroke, heart disease, and deep vein thrombosis. Combine hormone therapy (estrogen with progesterone) could cause an increased risk of breast cancer, stroke, heart disease, deep vein thrombosis, and gallbladder disease.
It’s also important to use the right type of estrogen for you. If you’re experiencing vaginal or menopause-related urinary tract issues, a topical estrogen applied directly to the vagina could be the best choice. If you’re experiencing a variety of symptoms or prefer to not use a cream, you may decide to go with an oral estrogen.
COUNSELING toenail sx care
-Take off all the bandage material. You can use warm water to help soften any material that sticks to the toe.
-Make a solution of 2 teaspoons of Epsom salts in 2 quarts of warm water. Put the solution in a large bowl, pan, or other clean container that is big enough to soak the foot. You may also soak in plain warm water.
-Soak the toe in the solution for 15 minutes.
-Dry the foot completely.
-Put a small amount of antibiotic ointment on a piece of bandage.
-Put the bandage over so the antibiotic goes on the place where the toenail was removed.
-Put a toe cap over the toe and tape it loosely to your foot.
Counseling testicular CA Yesim
Self testicular exam is advised for testicular cancer.
A testicular self-exam is an inspection of the appearance and feel of your testicles. You can do a testicular exam yourself, typically standing in front of a mirror. Routine testicular self-exams can give you a greater awareness of the condition of your testicles and help you detect changes. Self-exams can also alert you to potential testicular problems. If you detect lumps or other changes during a testicular self-exam, make an appointment.
It's not clear who should consider regular testicular self-exams. Though often promoted as a way to detect testicular cancer, testicular self-exams aren't proved to reduce the risk of dying of the disease.
Testicular cancer is a relatively uncommon type of cancer. It's also highly treatable at all stages, so finding testicular cancer early doesn't make a cure more likely.
patient is counseled approximately for 10 minutes for this specific subject.
COUNSELING kidney stone diet
Diet and Uric Acid Stones
Avoid these foods if you have uric acid stones:
Alcohol
Anchovies
Asparagus
Baking or brewer's yeast
Cauliflower
Consommé
Gravy
Herring
Legumes (dried beans and peas)
Mushrooms
Oils
Organ meats (liver, kidney, and sweetbreads)
Sardines
Spinach
Other suggestions for your diet include:
Do not eat more than 3 ounces (85 grams) of meat at each meal.
Avoid fatty foods such as salad dressings, ice cream, and fried foods.
Eat enough carbohydrates.
Eat more lemons and oranges, and drink lemonade because the citrate in these foods stops stones from forming.
Drink plenty of fluids, particularly water.
If you are losing weight, lose it slowly. Quick weight loss may cause uric acid stones to form.
COUNSELING kidney stone diet
*Fluids
Drinking a lot of fluid is important for treating and preventing all types of kidney stones. Staying hydrated (having enough fluid in your body) will keep your urine diluted. This makes it harder for stones to form.
Water is best.
You can also drink ginger ale, lemon-lime sodas, and fruit juices.
Drink enough liquids throughout the day to make at least 2 quarts (2 liters) of urine every 24 hours.
Drink enough to have light-colored urine. Dark yellow urine is a sign you are not drinking enough.
Limit your coffee, tea, and cola to 1 or 2 cups (250 or 500 milliliters) a day. Caffeine may cause you to lose fluid too quickly, which can make you dehydrated.
*Diet and Calcium Stones
Follow these guidelines if you have calcium kidney stones:
Drink plenty of fluids, particularly water.
Eat less salt. Chinese and Mexican food, tomato juice, regular canned foods, and processed foods are often high in salt. Look for low-salt or unsalted products.
Have only 2 or 3 servings a day of foods with a lot of calcium, such as milk, cheese, yogurt, oysters, and tofu.
Eat lemons or oranges, or drink fresh lemonade. Citrate in these foods prevents stones from forming.
Limit how much protein you eat. Choose lean meats.
Eat a low-fat diet.
Do not take extra calcium or vitamin D, unless the provider who is treating your kidney stones recommends it.
Watch out for antacids that contain extra calcium. Ask your provider which antacids are safe for you to take.
Your body still needs the normal amount of calcium you get from your daily diet. Limiting calcium may actually increase the chance that stones will form.
Ask your provider before taking vitamin C or fish oil. They may be harmful to you.
*If your provider says you have calcium oxalate stones, you may also need to limit foods that are high in oxalate. These foods include:
Fruits: rhubarb, currants, canned fruit salad, strawberries, and Concord grapes
Vegetables: beets, leeks, summer squash, sweet potatoes, spinach, and tomato soup
Drinks: tea and instant coffee
Other foods: grits, tofu, nuts, and chocolate
*Diet and Uric Acid Stones
Avoid these foods if you have uric acid stones:
Alcohol
Anchovies
Asparagus
Baking or brewer's yeast
Cauliflower
Consommé
Gravy
Herring
Legumes (dried beans and peas)
Mushrooms
Oils
Organ meats (liver, kidney, and sweetbreads)
Sardines
Spinach
Other suggestions for your diet include:
Do not eat more than 3 ounces (85 grams) of meat at each meal.
Avoid fatty foods such as salad dressings, ice cream, and fried foods.
Eat enough carbohydrates.
Eat more lemons and oranges, and drink lemonade because the citrate in these foods stops stones from forming.
Drink plenty of fluids, particularly water.
If you are losing weight, lose it slowly. Quick weight loss may cause uric acid stones to form.
Counseling diet HLD Yesim
Patient is educated about complications of HLD including CVD, stroke, PVD , fatty liver etc.
Counseled patient for 10 minutes about adopting healthy diet and lifestyle for HLD
-Be physically active for 30 minutes most days of the week. Break this up into three 10-minute sessions when pressed for time. Healthy
movement may include walking, sports, dancing, yoga or running. Add cardio exercise at least 10 minutes for 3 times a week.
-Eat a well-balanced, low-fat diet with lots of fruits, vegetables, and whole grains. decrease red meat ( beef, lam, pork) and increase white meat intake ( fish esp salmon, chicken, turkey). Decrease carb intake including bread, pasta, rice, potato, corn, sweets etc. No fried food. Choose a diet that's low in saturated fat and cholesterol and moderate in sugar, salt and total fat.
COUNSELING Serotonin Syndrome
Serotonin syndrome occurs when you take medications that cause high levels of the chemical serotonin to accumulate in your body.
Serotonin is a chemical your body produces that's needed for your nerve cells and brain to function. But too much serotonin causes signs and symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever and seizures). Severe serotonin syndrome can cause death if not treated.
Serotonin syndrome can occur when you increase the dose of certain medications or add a new drug to your regimen. Some illegal drugs and dietary supplements also are associated with serotonin syndrome.
Milder forms of serotonin syndrome may go away within a day of stopping the medications that cause symptoms and, sometimes, after taking drugs that block serotonin.
Serotonin syndrome generally doesn't cause any problems once serotonin levels are back to normal.
If left untreated, severe serotonin syndrome can lead to unconsciousness and death.
Signs and symptoms include:
Agitation or restlessness
Confusion
Rapid heart rate and high blood pressure
Dilated pupils
Loss of muscle coordination or twitching muscles
Muscle rigidity
Heavy sweating
Diarrhea
Headache
Shivering
Goose bumps
Severe serotonin syndrome can be life-threatening. Signs include:
High fever
Seizures
Irregular heartbeat
Unconsciousness.
COUNSELING MTBI
MTBI is mild and is synonymous with concussion
Concussion Sxs: HA, N/V, balance issue, blurry vision, light/sound sensitivity, feeling hazy or down, confusion.
Can’t recall events prior to or after a hit or fall.
Appears dazed or stunned.
Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent.
Moves clumsily.
Answers questions slowly.
Loses consciousness (even briefly).
Shows mood, behavior, or personality changes.
Return to daily activities:
Increased rest and limited exertion are important to facilitate the patient’s recovery. Physicians should be cautious about allowing patients to return to driving, especially if the patient has problems with attention, processing speed, or reaction time.
Patients should also be advised to get adequate sleep at night and to take daytime naps or rest breaks when significant fatigue is experienced. Symptoms typically worsen or re-emerge with exertion. Let any return of a patient’s symptoms be the guide to the level of exertion or activity that is safe.
Return to work:
Return-to-work planning should be based upon careful evaluation of symptoms and neurocognitive status. To help expedite recovery from MTBI, patients may initially need to reduce both physical and cognitive exertion. Rest is key. Restricting work during initial stages of recovery may be indicated to help facilitate recovery. Repeated evaluation of both symptoms and cognitive status is recommended to help guide management considerations.
Return to school:
Symptomatic students may require active supports and accommodations in school, which may be gradually decreased as their functioning improves. Inform the student’s teacher(s), the school nurse, psychologist/counselor, and administrator of the student’s injury, symptoms, and cognitive deficits.
Counseling: Safe Sex Yesim
What is safe sex?
Having sex with only one partner who only has sex with you when neither of you has a sexually transmitted infection (STI) is believed to be safe. However, many healthcare professionals believe there really is no such thing as safe sex. They believe the only way to be truly safe is not to have sex because all forms of sexual contact carry some risk.
For example, kissing is thought to be a safe activity, but herpes, and other diseases can be spread this way.
Condoms are commonly thought to protect against STIs. However, while it is true that condoms are useful in preventing certain diseases, such as herpes, chlamydia, and gonorrhea, they may not fully protect against other diseases, such as genital warts, syphilis, or HIV.
Guidelines for safer sex
Limit your sexual activity to only one partner who is having sex only with you to reduce exposure to disease-causing organisms. Follow these guidelines, which may provide for safer sex:
Think twice before beginning sexual relations with a new partner. First, discuss past partners, history of STIs, and drug use.
Use condoms every time you have sex. Choose a male condom made of latex or polyurethane--not natural materials. Only use polyurethane if you are allergic to latex. Female condoms are made of polyurethane.
Although studies say that nonoxynol-9 spermicide kills HIV in lab testing, it has not been determined whether spermicides, used alone or with condoms, provide protection against HIV. There are data that shows nonoynol-9 may increase the risk of HIV transmission, However, the CDC recommends that latex condoms, with or without spermicides, should be used to help prevent sexual transmission of HIV.
For oral sex, help protect your mouth by having your partner use a condom (male or female).
Avoid drinking alcohol or using drugs as this increases the chance that you will participate in high-risk sex.
Women should not douche after intercourse--it does not protect against STIs. And, it could spread an infection farther into the reproductive tract, and can wash away spermicidal protection.
Have regular Pap tests, pelvic exams, and periodic tests for STIs.
Be aware of your partner's body. Look for signs of a sore, blister, rash, or discharge.
Check your body frequently for signs of a sore, blister, rash, or discharge.
Consider sexual activities other than vaginal, oral, or anal sex. These are techniques that do not involve the exchange of body fluids or contact between mucous membranes.
COUNSELING OCP
The risks and side effects of COCs are influenced by the type and dose of estrogen and the progestin.
Briefly, common issues that we discuss with patients initiating or using COCs include:
●Frequent patient concerns – patients may experience breast tenderness, nausea, and bloating when starting a COC. These symptoms typically resolve quickly. Other concerns can include unscheduled bleeding, which typically resolves within three months, and the possible impact of COCs on mood and sexual function. There is no evidence that COCs cause weight gain.
●Venous thromboembolism (VTE) – COC use has been associated with an increased risk of VTE. The risk of VTE varies with estrogen dose and patient factors such as age, obesity, and smoking status. While the relative risk is increased, the absolute increase in risk is still low for most women and does not outweigh the numerous benefits of this contraceptive method, particularly when compared with the VTE risk during pregnancy and the postpartum period.
●Cardiovascular risk – COC use has been associated with increased risks of hypertension, myocardial infarction, and stroke in certain populations. However, the absolute risk of myocardial infarction and stroke attributable to COCs is low in women of reproductive age [10]. COCs can rarely cause a mild elevation in blood pressure in the range of 3 to 5 mmHg, which is unlikely to be clinically significant in healthy women.
●Cancer risk – COC use does not appear to increase the overall risk of cancer. The impact of COC use on breast cancer risk is a subject of active debate as the data conflict. At least one study has reported a differing risk of breast cancer with COC use based on hormone receptor subtype. Women who have taken COCs also appear to have a slightly increased risk for developing cervical cancer. By contrast, COC use is associated with reduced risk of developing ovarian and endometrial cancers. These issues are presented in detail separately.
https://www.uptodate.com/contents/combined-estrogen-progestin-oral-contraceptives-patient-selection-counseling-and-use#H591898128.